Insurance Billing 101

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Insurance 101 Insurance Industry

By The Boost Team on Jan 23, 2023

6 min read

A businesswoman uses a calculator at her desk.

The insurance market is huge and growing. But when it comes to collecting those payments, insurance is a lot more complicated than most goods or services. We’ll take a look at the factors that go into calculating an insurance bill, and what options companies have for billing methods.

What Makes Insurance Billing Complicated?

The reason why insurance billing is so complicated can be boiled down to one thing: state-by-state differences. Since every state makes its own rules for insurance, the requirements to stay compliant can vary significantly. Businesses that sell insurance in multiple states need to pay close attention to each state’s rules (or work with a partner that can help).

Here are 5 things that can make billing for insurance complicated:

1. Taxes and fees

Every state imposes its own taxes and fees, sometimes with different guidelines for how they should be collected. This means that if you sell insurance in fifty states, you need to stay up to date with fifty sets of rules for when and how to add taxes to your customer’s bill.

Different insurance products can also have their own rules, depending on both the type of product and its regulatory status. Admitted products, which are products that have met regulations set by the state’s Department of Insurance, have most (but not all) taxes and fees included in the premium. For non-admitted products, however, taxes and fees are billed separately.

Taxes and fees can cause complexity for more than just the policyholder’s bill. Some are commissioned on, meaning that they’re included in the amount calculated for an insurance seller’s commission, and others are not. This is yet another set of rules an insurance organization needs to track in their billing.

2. Installment variations

Besides just having different rules about how taxes can be charged, different states may have differing rules about how to charge for the premium itself.

As we saw earlier, the premium is the cost of insurance for the entire coverage period, frequently six months or a year. Going back to our earlier example: say an insurance policy covers a 12-month period for a premium of $600, with an additional $120 in taxes and fees. Depending on the state, the premium might be billed a number of different ways:

In installments, with all taxes and fees paid upfront. For our example, this would mean the first month's payment would be $170 ($50 for the premium, $120 for the taxes and fees). The subsequent 11 installments would be $50 each (premium only).
In installments, evenly divided throughout the term. For our example, this would mean twelve payments of $60 ($50 for the premium, plus $10 for taxes and fees).
In installments, skipping taxes and fees for the first month. For our example, this would mean a payment of $50 for the first month, then around $60.90 for each month after (with a few pennies’ variation between months, since $120 does not divide evenly by 11 months).

3. Non-payment cancellations

If the insured doesn’t pay their premium, what happens? The answer depends on the state. Usually you’ll send a notice that their policy will be canceled on a certain date unless they pay their bill, but the way that notice is sent may be dictated by state requirements. Some states mandate much longer notice periods before a policy can be canceled for non-payment. States may also have specific requirements around the language used in the notice, and how it’s delivered to the policyholder.

4. Refunds

If the policyholder cancels their policy partway through the term, they may be entitled to a refund. The amount of that refund, however, can be complicated to compute.

If the entire premium was paid upfront, how much of the term has passed? The appropriate amount to refund might vary if the policyholder cancels near the beginning of the month, versus near the end. Refunds might also be prorated to account for the part of the term that’s already over, in which case the amount refunded might vary based on the day of cancellation. Even the time remaining in the term may not be straightforward to calculate - different insurance products use different calendar types, and the number of days in a “year” or “month” can vary.

Separate from the premium are the taxes and fees. Depending on the situation, these may or may not be part of the refund. Some taxes and fees are considered fully “earned” at the beginning of the installment period or at payment - which means this amount would not be returned to a policyholder who cancels early. Determining which taxes and fees are included (and which aren’t) is an important part of any insurance refund calculation.

5. Midterm endorsements, and reconciliations

Any time an insurance policy’s coverages change, the premium amount changes too. If it comes time to renew a policy and the insured decides to add or remove coverages, the billing is fairly straightforward - the premium for the next period will reflect the new coverages.

If the policyholder wants to add new coverages before their policy term ends, however, it’s called a midterm endorsement. This is where things can get complicated, especially if the policyholder has already made payments toward the old premium amount. The difference between the old and new premium will need to be charged or refunded to the policyholder as a reconciliation. This isn’t as simple as just charging the difference between the old and new premium. The amount required for the reconciliation will depend on the time left in the policy, the amount already paid, and more.

Insurance Billing Methods: Direct Billing vs Agency Billing

We’ve looked at some of the factors that add complexity to calculating an insurance bill. However, determining the amount owed by the insured isn’t the end of it. There are multiple methods for how the policyholder’s premium can be collected.

The main reason for this relates to how insurance is sold. Many companies that sell insurance, like insurtechs, don’t build their own insurance product in-house. Instead, they partner with another company that’s already done that work to offer their product, whether that's an insurance carrier or a white-label insurance-as-a-service provider.

These companies then have two options for choosing a billing method: direct billing, or agency billing.

What is direct billing?

In direct billing, the policyholder pays the insurance carrier directly. With this form of billing, the company that sells the insurance is paid a commission after the carrier has received the premium.

With direct billing, the insurance carrier is responsible for all the billing issues we discussed previously, from taxes and fees to refunds, cancellations, and premiums. This can make it significantly easier for the company selling the insurance to get started, as they don’t have to build their own billing function around the product.

Because the carrier or insurance-as-a-service partner already has a functional billing system for the specific insurance product being offered, all the distributing company would need to do is build an integration to their partner. This can mean a substantial increase in time-to-market with a new insurance product.

What is agency billing?

With agency billing, the policyholder makes payments to the insurance distributor (i.e., the company selling the insurance product). With this form of billing, the distributor collects the commission upfront and makes retroactive, monthly payments to the insurance carrier. With agency billing, the company selling the insurance is responsible for calculating the amount owed, including taxes, fees, and any refund issues. The distributor is also responsible for the actual collection of money, which means they either need to integrate with a payment platform or build one from scratch.

This isn’t necessarily a hurdle; businesses that sell goods or services online likely already have integrated billing capabilities that allow them to accept digital payments. For example, a business that sells pet products online would already have online payment infrastructure, which could likely be used for embedded pet insurance. This has the added benefit of keeping all of the company’s business data in one place. However, some payment platforms can present user experience challenges, like policyholders having to re-enter personal information on the payment platform, after already providing it on the insurance application.

For businesses that aren’t yet set up to take payments, this is a function that would need to be built out before offering insurance with the agency billing method. In almost all cases, integrating with a best-in-class payment platform will be faster and more cost-effective than trying to build a proprietary billing system in-house.

Learn more about how Boost's platform can help you manage insurance billing complexity, or dive into building your insurance program with our comprehensive guide.

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Ready for Liftoff: BHMS Backs Boost

Jul 31, 2024

Friends of Boost, Today Boost is thrilled to announce that we have secured a significant equity investment from BHMS Investments, setting the stage for an incredibly exciting next phase for this company and the amazing team that has built it brick-by-brick over the past seven years. With a rock-solid foundation firmly in place, this partnership is going to supercharge our growth, fuel more innovation, and cement Boost’s position as the go-to infrastructure platform in insurance. We are on a mission to empower MGAs, insurtechs, independent brokers and agents, wholesalers, embedded insurance providers, and really any company that just wants to build, transact, and operate more efficiently in this technology-enabled world of ours. While capital is great, today is about hard-earned validation for our team doing that the right way since Day 1. BHMS is the perfect capital partner for Boost in terms of their insurance expertise and unquestionable track record in the space, but more importantly, they are fantastic people that share both our views on the industry and our principles of company building. The market is dangerously fixed for early and growth stage companies right now (and I say “fixed” intentionally). It’s incredibly easy to get picked off in an environment like that, so it takes a rare mix of both intellect and character to do the right thing when you’re on the capital side of that equation - and even more to be truly value-add to your portfolio companies. BHMS has that mix in spades and appreciated Boost for what it is, what it has accomplished, and what remains an incredibly high ceiling for this company vs. playing short-term charades with the herd. That’s our kind of investor. This investment isn’t just about the money—it's a resounding endorsement of Boost’s strength, credibility, and potential to make a truly meaningful impact on the insurance industry at scale. With BHMS now on board, alongside an incredible group of long-time strategic backers like Markel, RenaissanceRe, and Canopius, we’re ready to take our game to the next level. Our mission has always been to disrupt the insurance space with cutting-edge tech and unparalleled service, and this backing proves that disrupting responsibly is the only approach that works in our industry. Anyone can grow fast if they don’t care about quality or long-term credibility. At Boost, we underwrite profitably, we respect compliance, and we always - always - take a collaborative approach with our stakeholders across the entire value chain. As someone with literally zero patience, I can personally attest to that being incredibly difficult to do at times - but it scales. Even with the market’s ups and downs, Boost has been a powerhouse of innovation in the insurtech landscape with equal commitment to disruption and reliability. Doing things the right way does not mean you cannot innovate - or even disrupt - and leveraging best-in-class technology is not a right reserved for #insurtechs. Our platform has always been a one-stop shop for insurtechs and embedded insurance providers and MGAs, independent agents and brokers, and wholesalers alike - offering everything from product development to underwriting and program management to claims administration and reinsurance capacity. With our proprietary tech and a dream team of industry pros, we’re delivering smarter, more efficient solutions than ever before. Since our first program launched in 2019, we’ve underwritten over $200 billion in coverage, which is a somewhat staggering figure in hindsight. Today we’re proud to support programs for giants like Amwins along with trailblazers like Cowbell, Newfront, and Wagmo, and we’re grateful for all of the companies that chose to build with Boost even when Boost itself was just getting started. Our steady, disciplined approach has kept our portfolio profitable and we like to think that has kept our partners in front of us very happy as well. All of Boost’s success is thanks to what is hands down the best team in the industry. Hard stop. Their grit, dedication, and willingness to tackle tough challenges head-on has been crucial. Boost’s commitment to quality starts with our team and is reflected in them every single day. We keep things lean at Boost because that quality always outperforms quantity. Even if that approach always requires more from each individual and makes the stakes a bit higher, working with the right people makes the returns on each long hour invested that much more gratifying. Few people exemplify those principles or have demonstrated such an unwavering commitment to Boost more than Jeremy Deitch, so I am also thrilled to announce that Jeremy has been promoted to President at Boost and will join me on our Board of Directors. Jeremy’s leadership has been critical since the day he started at Boost almost 6 years ago, following probably the most grueling interview process in our company’s history - one he is always happy to dramatize even more if you ever ask him. ;) I couldn’t be more grateful to have a partner like him as Boost soars to new heights. With this new investment, we’re geared up to boost (pun intended) our growth and expand our tech offerings. We’re planning to scale our MGA programs, roll out new products, and snap up some strategic acquisitions. Our goal? To make building a business in insurance easier, faster, and more efficient for everyone so they can better serve their customers. We’re more fired up than ever about our mission to empower insurance providers with the tech and infrastructure they need to thrive. This partnership with BHMS is just the beginning. The future is bright, and we’re ready to lead the charge. Thank you to everyone who has been part of our journey thus far. Let's all keep pushing boundaries together - because the best is yet to come. Special thanks to the team at Howden Capital Markets & Advisory for helping Boost always say what it’ll do and do what it says. You can find our full press release here and, more importantly, can start joining our platform here. All my best, Alex Maffeo CEO & Founder Boost Insurance

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What is a Cell Captive?

May 23, 2024

A captive is an insurance entity that a business creates, rents, or owns in order to self-insure risks. A cell captive, sometimes also called a protected cell captive or segregated cell captive, is a specific insurance captive structure that allows an entity to segment or separate business in one cell from that in another cell, so that a particular cell’s assets and liabilities are insulated from anything that happens in another cell (even if both cells are part of the same overall captive facility). Using captives to self-insure risk offers businesses a number of benefits: they can participate in some or all of their program’s underwriting profitability, maintain end-to-end control over risk (including pricing and claims handling), and avoid paying significant overhead fees to a “middleman” insurer. Companies have several options for structuring and utilizing an insurance captive. They might build a single-parent captive, pool risk in a group captive, or make use of a cell captive. In this blog, we’ll take a look at each. In a single-parent captive, a company will often partner with a fronting carrier to reinsure at least part of their own risk. These are most commonly used by very large companies with exposure to multiple lines of business, which they can insure through the same captive entity. Example: A national food-delivery business wants to provide insurance to its restaurant partners, to protect against the risk of lawsuits related to food safety for meals delivered through the service. It discusses partnerships with several major insurance carriers, but none are willing to provide the level of coverage that the business is looking for at a reasonable price. To get what it needs, the food-delivery business sets up a captive to reinsure a fronting carrier partner, enabling the business to insure its own risk and provide the coverage it needs to its restaurant partners. Setting up a single-parent captive is a considerable undertaking with high capital requirements and a complex setup, with significant ongoing operational requirements going forward. In order to make sense financially, it usually requires a high volume of premium. For that reason, this option is usually only viable for very large businesses. For businesses that can’t afford (either in time or in money) to set up their own captive, a second option is to partner with other businesses in a related industry to set up a group captive. In this scenario, a single captive maintains portfolio capacity that can be shared by a group of entities. The entities can then pool risk together in the single captive. Example: Several real estate companies form a partnership to share a group captive to pool their similar risks. Each company contributes a certain amount of capital to fund the captive, and the capacity is shared among the partners. The participating real estate firms are then able to leverage the captive’s capacity to exercise greater control over their risk, and avoid paying high fees to middlemen. This can allow the partner businesses to share risk (and benefits) between them, and works well for trade associations and other groups of companies in related industries, that share similar risks. However, since the fund is shared between partners as well, one partner’s negative returns can impact the other partners involved. In a cell captive, the business first sets up an entity called a core, which is a similar process to setting up a single-parent captive. Once the core entity is complete, however, the business can much more easily spin up additional cells within the captive structure. The financials for those individual cells are separate from each other, rather than the combined funding of a single-parent or group captive. For many companies, however, using a cell captive doesn’t mean building one themselves. While there are use cases for single-parent cell captives, most businesses that create them then rent out cells to other businesses. Using a cell in another company’s captive entity (also called captive-as-a-service) allows a business to reap the benefits of an insurance captive at a much lower cost. We’ll look at some examples in the next section. The first step in creating a cell captive is to create the “Core” entity. This process is similar to building a single-parent captive: Once the core captive entity has been created and adequately funded, the owner can spin up individual cells within the captive’s structure to support different lines of business, segments, or partners. The Department of Insurance will still need to approve all new cells, but the process is much more streamlined than in prior cases. New cells can often be set up in weeks instead of the months or years typically needed for entirely new captive entities. Captive cells’ assets and liabilities are then statutorily protected from each other (which is where the ‘protected cell captive’ name comes from). This means that if one cell has a difficult year and experiences significant underwriting loss, the assets of the neighboring cells can’t be used to fund that loss. There are multiple ways that cell captives are used, including offering captive-as-a-service (also called rent-a-captive) to other partners or businesses, and separating different parts of the parent company’s business for performance tracking. In a captive-as-a-service or rent-a-captive scenario, the company that owns the captive core would allow other businesses to use cells in its captive. For a fee, the owner can set up a new cell specifically for the partner business, and manage it on their behalf. This lets the partner business leverage the owner’s infrastructure to achieve many of the same benefits of a single-parent captive, without the cost and complexity of creating one. Example: An insurtech specializing in commercial insurance has built a very strong customer base, and wants to further grow its business by participating in some of its own risk. However, building a full captive is too resource-intensive for the insurtech to take on. Instead, the insurtech partners with a CaaS provider and rents a captive cell. The insurtech then uses the cell to self-insure some of its risks, enabling it to participate in the underwriting returns and further scale towards a full-stack insurance business. While the most common reason for building a cell captive is to rent out cells to other businesses, there are a few reasons a company might build one for its own use. Because the cells’ financials are statutorily separated from each other, a cell captive allows a large enterprise to delineate between different lines of business or geographic regions, and monitor their performance separately. Example: A nationwide property management company offers several insurance products to its customers to help protect their personal property and finances. For planning and budgeting purposes, each line is supported by an individual cell in the management company’s cell captive. Over the course of the fiscal year, several lines perform over their targets, while one line significantly underperforms. The other LOBs’ budgets are unaffected by the low-performing LOB’s losses, and the company has clear visibility into which of its products are doing well and which may need a course correction. Cell captives provide a number of benefits to both their owners and the end users: Cell captives are popular for a reason: they offer significant value to both the companies with the resources to build them, and the companies that would rather rent a cell than build a single-parent entity from scratch. To learn more about Captive-as-a-Service with Boost, contact us.

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Partnerships and Focus: Big Trends at Money20/20

Nov 3, 2021

It was a busy October for the team at Boost Insurance, wrapping up with one of our favorite industry events: Money20/20. The conference was a super interesting contrast to ITC which was laser-focused on insurance, while Money 20/20 was more about fintech in general and much, much bigger! With fintech about ten years ahead of insurtech in terms of maturity, it’s interesting to see the level of innovation and diversity of companies in our big brother industry. Here are some of the big trends we noticed. One of the really interesting trends that kept being repeated at Money20/20 was a shift in mindset among both fintechs and banks. In the past, they have tended to see each other as competition for consumers’ business and attention but now everyone is moving towards viewing each other as complementary vs. competitive. We saw multiple collaborative efforts between the upstarts and the established, working together to create a better customer experience. This works because they each have a specialization (fintechs excel at meeting modern consumer expectations and banks are experts in profitably navigating a very regulated, very complex business), and partnership lets them bring both those strengths to the table. This was extra interesting to us at Boost because it reflects what we see in insurance, with insurtechs and carriers working together and bringing their own strengths together to meet modern consumer needs and expectations. For example - Boost has built a modern tech platform making various insurance products available via API but partners with established reinsurance companies to facilitate risk transfer. There will still be winners and losers between the incumbents and the upstarts, but as collaboration and competition continue consumers will be the clear winners. A trend I’ve written about before, and one that we continue to see play out, is tech companies’ focus on affinity groups. Fintechs are springing up all over with explicit goals of serving a relatively narrow group of people and serving them well. Companies like Paceline for people focused on health and wellness, Daylight for the LGBTQ+ community, and First Boulevard for African-Americans are just some of the fintechs concentrating on being the best option for a specific set of consumers. This is pretty much the opposite of traditional one-size-fits-all programs - instead of creating something broad that can be good enough for the biggest slice of people, creating something very targeted that can be great for a specific niche. This trend is great news for consumers who traditionally have not been served well by financial services in general. At Boost we’re starting to work with more affinity-focused companies because our modular, customizable product structure allows partners to tailor insurance for their customer needs. It’s exciting to be part of making insurance more accessible to all groups of people! Finally, it was really exciting and validating to see so much interest in new approaches to traditional industries. Finance and insurance have historically had a reputation for being very slow to change, sometimes for good reason (highly regulated, handling people’s money is a big responsibility, etc). This year though there’s a ton of interest in potential innovations, look no further than the enormous presence of blockchain and crypto-focused companies at Money20/20! Boost met with a TON of different companies during the show, and we cannot talk about anything yet but be on the lookout for some very interesting things coming in the near future! Money2020 was a heck of a conference and while my conference year is wrapped, the Boost team will be out and about at shows the rest of the year. We are looking forward to more opportunities to meet people in 2022, so if you did not get a chance to connect with us at Money2020, just drop us a line.